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HomeMy WebLinkAboutPTARMIGAN VIEW ESTATES LT 3Ptarmigan View Estates Lot 3 #015-271-49 Municipality of Anchorage 1jePartment P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 w (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221031 COSA#: Permit#: PID#: 015-271-49 and 015-271-48 Legal Description: PTARMIGAN VIEW ESTATES LT 3 and PTARMIGAN VIEW ESTATES LT 4 Engineer: Grant Mathews, PE Due to the public sewer main extension for the proposed Sky Ridge Subdivision, a sewer manhole will be within 100 feet of two of the neighboring lots. The approved separation distances are 82 feet to the well on Ptarmigan View Estates Lot 3 and 98 feet to the well on Lot 4. See the engineers waiver request located in the subdivision file. Waiver is Granted: X Waiver is not Granted: Date: v %/01-?— Approved by: Lell- Name of Reviewer f **** VARIAN C E/WAIVER REVIEW **** Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSPI31314 PID Number: 015-271-49 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Q Upgrade Name: Lowell & Laura Upton ABSORPTION FIELD ❑ Deep Trench ❑Q Shallow Trench E] Bed ❑Mound Address 11121 Hane Street Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot Ptarmigan View Estates 3 Fill added above original grade _5 Ft. Gravel length 40 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 400 Ft z One Ft. Well >100' >100' NIA N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 11,000 Gal. Surface Water >100' >100' N/A N/A Material Steel Number of compartments 2 Lot Line >10' 2' N/A N/A NA Foundation >5' >10' NIA N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Lot Line Waiver No. OSP131315 Pump on level at in. Pump off level at in. High water alarm at in. Flow Diverter Valve Place and Existing Trench Remains for Future Use. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank drainfield D3034 Installer G&S Excavation Drainfield D3034 CO/MT Inspector W. Roberts BENCH MARK (Assumed elevation) 100 ft Inspectiones: 1" 9/18/13 9/18/13 Location and description 2nd Garage Slab. 3rd 4"' COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF A. Conditional Approval: Date � 'PC . S � '-7��� i Com,. * : 49 TFi .....................� • Michael E. Anderson61 �'�'• Approved Date4II q 4381-E •'���f -' PROFESS\Q* ®�®®; Inspection Report_9-1-12.doc M CA O I N r N N C3)CL _ 1 avxsutavr xccxmxr CL O O z 0 CL ,00.O L l 3„ L£,01.00 N 10' Utility Ea merit O O z 0 M 144- J '^ M LO LO Q LCII 1.00 G LT m Lo 1011)l4 0- O ui Lij -C¢0 U) c W I— Q <C U cLa cn > U w Ll.l �U)Q �- ` tj 1n � O .2 z ai W J N > � o� z �m W -- m � C—C G m O U) Q O n N G ¢ (n V z V G O C P C O 3 7 0 m e 0 .4- L) U YJ \ F \ L \ \ 0 , m z T \ to D C \ U 3 � \ c � o c N c X O W a \m° 0 0 c aa > v c n c d 2 z a vU F = d j > 0 6o0 7 G 3 �o0 000 W m F- o IIIIII LLJ J �Oi toiO t rn Ic .X W ma CO AV ,..'L ,o ®® _o_ A®rHANE ST 10 :4j: z W s HERITAGE HEIGHTS DRIVE 10Q U 7 � -�o N O� Z ®�: O' ca S� a Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage; AK. 99519-6655- 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP131314 PID No. 015-271.49 101.5 T N U (n U , EzisGng Finished Ground Ground 1000 Gallon Y96.5Septic Tank 96.3 100.1 99.6 Finished Grade OG Geotextile>Fabric 95.6 Drainfield Rock 95.6 91.6 40' (Trench Length) 85.6 No Groundwater 9-22-13 PTARMIGAN VIEW 'ESTATES LOT 3 _ ' 0 49th ffi. ..... >� AIA j� .� s 3 Oj� I L s ®' L ® �rs�r.........� ®� MICHAEL E. ANDERSON w� �®��fT No Scale NO CE 4381 _A Ar ®mF,p� '. 7> 1 j.• DEPTH (feet) 1 3 4 5 6 7 8 9 1 1 1 1 l 1 1 1 1 L' 2� SOILS LOG AND PERCOLATION TEST LEGAL DESCRIPTION: PTARMIGAN VIEW ESTATES, LOT 3 PERFORMED FOR: LOWELL UPTON DATE: 9/5/13 PROJECT No.: PARCEL ID#: 015-271-49 TECHNICIAN: W. ROBERTS COMMENTS: TEST HOLE V OG GM (SILTY GRAVEL) SLOPE WAS GROUND WATER ENCOUNTERED? NO IF YES a WHAT DEPTH? - L DEPTH OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 9-22-13 P E SITE PLAN SEE SITE PLAN R DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 9/15/13 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 2:13 .50 2 2:43 30 7.63 7.13 3 2:44 .38 4 3:14 30 7.38 7.00 5 3:15 .50 6 3:45 30 7.50 7.00 PERCOLATION RATE: 4.3 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131314 Tax Code Number: 01527149000 Work Type: Septic Permit Effective Dates: September 16, 2013 to September 16, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: PTARMIGAN VIEW ESTATES Site Legal Address: PTARMIGAN VIEW ESTATES LT 3 G:2634 Owner/Address: UPTON LOWELL R & LAURA M 11121 HANE STREET ANCHORAGE AK 995161442 Site Mailing Address: 11121 HANE ST, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: gent ftepartmf,nt 1713 11:3�Y � r Lot Size in Sq Ft: 21986 Total Bedrooms: 3 N Private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The Engineer needs to do a complete test hole, including groundwater monitoring and percolation test, prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. Received By. r L Issued By:✓//(/u . Date: �� t Municipality of Anchorage Ment Mtm,�n Depart **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP131315 COSA#: Permit#:OSP131314 PID#:015.271.49 Legal Description: Ptarmigan View Estates, Lot 3 Engineer: Anderson Engineering Applicant: Lowell and Laura Upton Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Revi W r .................................................. a....... .................... Rec#: 05350G Amount: $200.00 Date Paid: 916113 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE _ f Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-271-49 Property owner(s) Lowell and Laura Upton Mailing address 11121 Hane Street Anchorage, AK 99516 Day phone Site address Same Legal description (Sub'd., Block & Lot) Ptarmigan View Estates, Lot 3 Legal description (Township, Range & Section) Lot Size 21,9$6 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Field ❑ Initial F-1 Single Family (SF) Single El ADU) Septic Tank ElUpgrade ❑ Duplex (D) F-1Holding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Lot Line Dis tance: 1 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: 05351D C> Permit No. ®5P Permit App_9-1-12.doc Waiver Fees: 01.00 Date of Payment: 0111611a Receipt Number: 05-3 r Waiver No. �S?l�I b 15 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 6, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 3, Ptarmigan View Estates Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on the subject lot has failed and must be replaced. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing Septic Tank will be uncovered, inspected and verified suitable for continued use. The existing absorption trench will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows and ground surface contours are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot in the past indicated Well Graded Sand (SW) to a depth of 14'. No groundwater was encountered. The lot is located near the old Pioneer Gravel Pit and soils in the area are known to be free draining and dry with no evidence of bedrock. The absorption rate in the GW soil lense was determined to be 125 gallons per day per bedroom. A percolation test and test hole will be completed prior to construction to verify the subsurface soil conditions on the lot. Any variation from the anticipated conditions will require a change order and a redesign of the new system. We have designed the new trench with an application rate of 1.2 gallons per day per square foot. We are proposing to place a 40' long by 5' wide absorption trench with a 4' effective depth. The total depth of the system will be 8' with the distribution line at 4' below the existing surface. A flow diverter valve will be placed to connect the existing Lot 3, Ptarmigan View Estates September 6, 2013 Page Two trench to the system for future use. The ground surface on the lot slopes to the west in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766(f September 6, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 3, Ptarmigan View Estates Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: A new absorption trench must be placed on Lot 3, Ptarmigan View Estates Subdivision to replace the existing failed trench. The lot is only 110' wide and the location of the well and existing septic system occupy the majority of the usable area. The new absorption trench must be placed within 1' of the south property line. Placement of the trench in this area does not impact the property to the south or the septic system. We recommend a waiver be issued allowing the trench to be 1' from the south property line. Sincerely, -nl�LJ Michael E. Anderson, P.E. LOT 6 ES PTARMIGAN VIEW ESTATES kLOT I LOT 5 PTARMIGAN VIEW ESTATES --YLOT 4 PTARMIGPN VIEW ESTATES11 l I/ t A % Ei i ILOT 2 I PTARMIG414 VIEW ESTATES �V L EAST 1112TH AVENUE I 1 —_—___— .w*oraag1ll • +i 49th� f . f ND ff MICHAEL E. ANDERSON ff��fT:, AREA MAP No. CE -4381 : ; M ++F� ••..9: c� .• !!��PROFESS SCALE 1" = 100' !!lsFESS\r� V \ zC9 atii24Una0i om25a,o'o> 0 10' utility Eas Ment LIJ X$cm i W o p>0 � � � J Sf YiFO4N L \ mV \ mu a i �II .mom m� F-- � �\ 00 �\ O v� \y O r M it � O U% °Z O W _N \ ri �o �% N M _—�, L_ m E Vi J p m O2-. Q O Q �U7 �Z \ `tom ,UV '.�� '�£ya'n Ld U Z E-- rn �� • A ® in o 3 m `o �i � 9_ N q m n 1 1 \\\ m 0 \\mmma Z � ✓3m wha` �_� \ \ W a Lo HANE 5; HERITAGE HEIGHTS DRIVE •1�3 w w/ LOT 3, PTARMIGAN VIEW ESTATES SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS Three Bedroom Home 5' Wide Trench System Perc. Rate: 3-5 Min./Inch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 3 Bedrooms' 150 GPD/Bedroom =450 SF Absorption Area 450 SF/1.2 GPD/SF/5 SF (Width) ".5 (Red. Factor= 37.5 LF Trench Length THEREFORE: Construct a 40' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 8' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. Place Flow Diverter Valve and Tie In Existing Trench for Future Use. 5' TYPICAL 5' WIDE TRENCH SECTION --_•.� (NO SCALE) ��..P�E.OF q1" NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ,...,. astn Minimum 4' Separation From Groundwater. rw;1.,� C i........................... .. Minimum 100' Separation From Private Wells in the Area. �� m:- N11CHAELE. ANDERSON Minimum 100' Separation From Surface Water or Streams. �jc4n,'.. No._ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE IZNEW KUI' pf4,H q 263.440 ❑UPGRADE MAILING ADDRESS /7Z2- a,; k !�� Odra lQs 9 4 ., - - LEGAL DESCRIPTION h07 LOCATION NO. OF BEDROOMS 3 DISTANCE TO: Well / / / _F � Absorption area Dwelling �� PERMIT NO. 64003 UY -5--r4 H Z W Manufacturer ire Material 54e / No. of compartments Z-- � er, tn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. J t=Z C)'3 Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: WellFoundation /OZ Za �f Nearest lot line ` �� -Ff PERMIT NO. �/ 8¢O1897 J LL Z No. of lines Length of e ch line Total len th of li es Trench wi th Distance between lines Z w U -F pinches NIA Top of tile to finish grade A `� Material beneath tile Total effective bsorption area O _� o inches QO Jr- Length Width Depth PERMIT NO. W C7 Q H CL s W Type of crib Crib diameter Crib depth Total effective absorgjlj glq�r� l ITY C� f ?dCLIC)PA^vE W DISTANCE TO: Well Building foundation GF Nearest lot line ENVIRQid!1',C:`!i/. J Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Abs ofption areals) i OTHER el PIPE MATERIALS SOIL TEST RATING IZ S INSTALLER REMARKS Z 4?i/oh M u 00 - 40 JFF APPROVED DATE LEGAL �Y L1J4--A, 72-013 (Rev. 3/78) 7,. ,3/ M -W DRILLING, Inc. P.O. Box 10-378 • 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner KAF1 PFAU Location (address of: Township, Range, Section, if known; or distance main road Lot 3 Ptarmagrain View Estates ,'!. - Size of casing 6�� Depth of Hole 242 feet Cased to 241.5 feet of Well Eosestic Static water level 195 ft. (aRVb) (below) land surface. Finish of well (check one) open end ( ,v, ) Screen ( ) ; Perforated Describe screen or perforation Done Well pumping test at T gallons per (Mii?-) (minute) for 1 hours with 1000p, :fit of drawdown from static level. Date of completion May 31, 1984 WELL LOG Depth in feet from GE ground surface Give details of formations penetrated, size of materialj-�PLqr Am�Ra'dness -11 TO 2 LTO 3 3 TO 15 15 TO 24 24 TO 32 32 TO_ 511- 25T 5TTO 68 68 TO 109 109 TO -13-3 133 TO 185 185 TO 209 20 _ o 2d3 223 TO 236 236 TO 242 TO- .TO MUNI 'XPi- 0' VAr-r—O CIION Casing stickupP,- E Organics Silty Sand _ r Iv F IJ Sand w/sone Gravel Sand °and & Gravel Sticky Silt X"A Certified Contraefslt Gravelly Hardpan C -Xa's. 814 & 929 Sand & Gravel Waterbearing Gravel- ravel 3—CONTRACTOR 3—CONTRACTOR MUNICIPALITY OF ANCHOKAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET: ANCHORAGE, AK 99501 ?64-4720 A -e t=1►Ita--- I TE SEWER' .+' WELL F="eFR 1 I T PERMIT NO: 840169 DATE ISSUED: 04/16x'84 APPLICANT: KARL F. JR PFAU ADDRESS: 11-22 BR I NLE P544(1- ANCHORAGE.- 44«ANCHORAGE: AK 99504 CONTACT PHONE: 253-4448 LEGAL DESCRIP: SUBDIVISION: PTARMIGAN VIEW EST. LOT: = BLOCK: NA SECTION: 21 TOWNSHIP: 12N RANGE: 3R LOT SIZE: 20000 (SQ.FT. OR ACRES) MAX BEDROOMS: LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. - - - - - - - - - - - - - - - - - - - - - - - - - - TFiEI" (-_" - - - - - - - - ®s1_=C} - - - - - - W- E>FZfi I �`+1 DEPTH TO PIPE BOTTOM (FT.) 4. 0 4.0 4.0 GRAVEL DEPTH (FT.) 6.0 0.5 3.5 TOTAL DEPTH f FT. ) 10. 0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 17.0 5.0 GRAVEL LENGTH (FT.) 32.0 34.0 41.0 GRAVEL VOLUME ( CU. YDS. ) 19.2 21.4 30.3 TANK SIZE (GALS) 11000.0 ** 11000.0 ** 11000.0 ** SOIL RATING < SQ. FT. /'BR) 125 125 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN CrOMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REGUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED: (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORTi AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED _ -- r ---- ------------- DATE. APPLICANT: KARL F J PF ISSUED BY ---- DATE: - - - ---- ------------ -- -- --- ��������-�-IF Ci F=' "r-4C.."r��13 E ^y DEPARTMENT [ HEALTH AND ENVIRONMENTAL / JTECTION 825 'L' STREET, ANCHORAGE, HK. 99501 264-4720 14EOL-L- -V[—= F='E:F-_'r-1 I _T" PERMIT NO. ( 820251 ) APPLICANT KARL F PFHU JR SRH BOX 6668 PALMER 99645 263-4448 LOCATION LEGAL L] PTARMIGAN VIEW ESTATES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = � SOIL RATING (SQ FT/BR)- 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: -1 C-1: 1 :E�::2 13F-'F=f0-.-lF=L_ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �En Ex ����I 1:__' _F Fs PA to I :E"FE Ct Ct Ca C3 FA L. L. CD f4 c PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. �L--i Cl -c- ;2 F"E—= C_ -T I Ci F:l�� ��������� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUQJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL HINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. _F ��F" I F! E: ���1—= ir-1 E3 E� Fe :jL� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. �_ SIGNED:___ _ ____________ APPLICANT KHRL FPFHU ISSUED Permit #: 820712 January 31, 1933 TO: Permit Applicant. Subject: i,ot I'tamiclan View Fstates Subdivision A permit issued by this department for an individual well and/or on -kite sewer system has expired as of December 31, 1982. Permits ,_ire issued on a calen,'ar year basis, as stated on the permit, by -authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to t=his denartment for documentation of the installation date an.1 to close the permit. I} a private engineer inspected the installation of the on-Lsi_te sewer system, please have them send us the as-builts for our `dies and documentation. If there are any further questions, please call this office at 264- 1720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 `i Permit #: 820712 January 31, 1933 TO: Permit Applicant. Subject: i,ot I'tamiclan View Fstates Subdivision A permit issued by this department for an individual well and/or on -kite sewer system has expired as of December 31, 1982. Permits ,_ire issued on a calen,'ar year basis, as stated on the permit, by -authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to t=his denartment for documentation of the installation date an.1 to close the permit. I} a private engineer inspected the installation of the on-Lsi_te sewer system, please have them send us the as-builts for our `dies and documentation. If there are any further questions, please call this office at 264- 1720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 TYPF 0w �y[L q?9ORpTION SYSTEM Ii TREMC' H/'/!QEQ '}F 5EQROOMS ` :K SOIL RHT[NG (SO FT/5R)`125 THE 9EQ'/IPE& T[ZE OF THE SQ[n PESQpPTlON jYSTEM IS� t> EYE §0, -A- bi �1. Qj i.. EE: K 1 0T X 1-1 - - 711,22 0:1 Fo by %A FE L_ CA F> 1F 41_` � 7H4 LENGTH 01HENSlON lS THE LEN67H IN FEET) OF THE TRENCH OR DRHlNFlEL� THE PEPTH OF H TRENCH 04 PIT IS THE DISTANCE 8ETWEEH THE SURFHCE OF THE �RO�N� 9ND THE ROTTOM OF THE EYCHvHT[ON (IN FEET` THERE IS mO EET HIPTH FOR TRENCHES. THE SRRvFL QEPTH IS THE MINlhUM DEPTH 9F GPHYEL BETWEEN THE OUmFOLL 010E 9Hh THE BOTTOM OF THE EY[H»qTI0N CIM FEE!" fv! IE I! " PJ 1: FT! EYE E: - 07 Fill F21 11 01- 1- 0-1 Q4 p< 57 1 21 K= J. CD to to CA to C. t.B44E. PER|1Ir HpPLlC9HT HAS THE RESPONSIPlLITY TO INFORM THK OEPHRTMENT DURING THE TMSTRLLRTTOM INSPECTIONS OF 9NY HELLS HD}HCENT 70 THIS PROPERTY HND THE NUMFER OF RESIDENCES THAT THE WELL WILL SERVE X bi 170 C 11) r-4 70 low FQ FET iv�������� ?Hr'cILLIN6 OF HNv SYSTEh HITHOUT FINAL [NSPECTION AND APPROVAL GY TK[� DEPORTMENT KILL BE SUBJE[r TO PROSEC']'1uk NTNIMUM 14ISTHNCE BETWEEN H WELL AMD HM OM -SITE SEWAGE DISPOSAL SY5TEM lS 100 FEET FOR H PRIVATE |,ELL OF 150 TO 200 cEET FROM H PUBLIQ WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. NIMIall UM �iSTHNCE FROM H pRI;PTE HELL TO H PRIVATE SENER LINE IS 29 FEET KMEP T� !-! �NlTY SEWER L[ME TS �5 FEET HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE EEP9RTMENT HlTHIH S0 DQY� OF THE WELL COMPLETION OTHER REOUIREMENTS MAY APPLYSPEClFlCHrIONS HME CONSTRUCTION DIHGRHMS HRE AYAlL9PLE TO INSURE PROPER lMST9LLQTlQN F0020'R!"! I I- K 7- 4 4, .11 FREE to CA EE CD EE rl Eon FEE IT: :11 J.' JL!0&r Q: I rEPTIFY THAT L [ HH FHMILIHR WITH THE REOUIREMENTS FOR ON-SITE SB'!ERS HND WELLS WS KT TOOTH SY THEE MUNIC1PHLITY OF RHCHDRHGE. 2 T HILL INSTALL THE SYSTEM IN HCCORDHNCE HITH THE CODES. 1 I UNDERSTAND THAT THE DN -SITE SEWER SYSTEM MRY REOUIRE ENLqRGEMEMT IP THE RESI['EWCE IV REMODELED TO INCLUDE MOPE THAN 1 BECRO']MS HNr En/:'. ` lSS/''E& ()( SOILS LOG MUNICIPALITY OF ANCHORAGE • +.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Ll PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1IARQ%iI RM llrt-E R DATE PERFORMED:_ �I so j r LEGAL DESCRIPTION: Lai 3 r'T4rYV11:4:Ly) V 1 •Cy. Fs^44-- SLOPE SITE PLAN �R�iAN1L SOIL. 1 Lo...vH 7 3 . 4 5 r' �4,40�, c -G� .,. 7 O cc.a. 9 . 'rl , 10 11 WAS GROUND WA ENCOUNTERED? 12 , IF YES, AT WHAT 13 } DEPTH? 15 OF 16 y; •.9, 17W *as ri 17 ,Illy.as ease 6 6866. .� �. O 18; , 2225-E a• NE 25,1971 �i 19 ?Oi�ss 20 COMMENTS PERFORMED BY: C . 72-008 (6/79) TER �-� S L O P E 40 Reading Date Gross Time Net Time Depth to Water Net Drop Soo M - TER �-� S L O P E 40 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE_ TT RUN BETWEEN fl, -196 aV CERTIFIED BY: FTA AND (minutes/inch) FT F4 cc. rest 11;2a .4&.*- .7 DATE: i MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES. AHM Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 / CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01-57- 2 71 r *9 HAA # R Pr C� I`E o SZJro 1. GENERAL INFORMATION Complete legal description Lo -r 3 PrAR_PA16 At NJ Location (site address or directions) Property owner FTS AJ K PAS IL VA'\J Day phone Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well xx X Community well Public water Day phone Day phone 5 -z --Z— 1019, NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X X, A,_ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm AnlD cRS o A Gi�CCRa� (, Phone Address PC), 7-L{D7 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. )L g9sz Date /V lqlq 1W, -!I f •� M^�G Michael E. Anderson t U '• 4381 - E Conditional approval for bedrooms, with the following stipulations: Additional Comments By: a- Date AD /X Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M Mw. 1/91) Beek MOA 371 Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -o T' 3 PrA2M1 (f �IcW Parcel I.D. A. Well Data Well type -PR i v A-P-C Log present (Y/N) Y Total depth G `� Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell If A, B, or C, attach ADEC letter. ADEC water system number ^) /A Date completed 91B4 Driller M- �J b 2► L- L-1 fJ t4 Cased to Z �' Casing height FROM WELL LOG S- -3 1 1Z Y, — /9S' ` %I LAQ �4WoJAt SEPARATION DISTANCES FROM WELL TO: t Septic/holding tank on lot Absorption field on lot W e- Wires properly protected (Y/N) Z, " AT INSPECTION m 9/Zq�9 C o rn M p.m. 5. J g.p.m. M o _ L ,0' cz T Cn M r'm On adjacent lots / �a 7 r ; On adjacent lots > iD Public sewer main M , c.0 Public sewer manhole/cleanout > l A'1 i Lc Sewer service line > IDO f Petroleum tank AJ0,Q WATER SAMPLE RESULTS: Coliform n Nitrate L` M-9 A— Other bacteria � Date of sample: 9�z`/ /9 4 Collected by: A 14z -A t -A B. SEPTIC/HOLDING TANK DATA Date installed Gh�`f Tank size /UDa C:74LS Compartments 7w � Cleanouts (Y/N) Y `Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) /► Alarm tested (Y/N) /,,[/A Date of pumping 7/j, l q q" Pumper -T— S !VA C, (S Poo I� i rJ L� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots UL7 / Foundation i To property line ?"*-AO Absorption field Water main/service line Surface water/drainage > /5 D' 7 >/O, 72-026 (3193)• Front CONTINUED ON BACK PAGE C. LIFT STA Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes SEPARATION lot "Pump on" level at FROM LIFT STATION TO: D. ABSORPTION FIELD DATA %A _Manufacturer _Manhole/Acc �IN) "Pump off" Level at Cycles On adjacent lots Surface water Date installed ZP, `f Soil rating (GPD/Ft2) /Z5 FrL 662M System type ��-�_ u+ Length Width f Gravel thickness S Total depth 9 Total absorption area q'90 L Cleanout present (Y/N) Y Depression over field (Y/N) Date of adequacy test 9 z 9 - 30 9 4 Results (pass/fail) Water level in absorption field before test 3 `� Peroxide treatment (past 12 months) (Y/N) Al SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /V Z_ Onadjacent lots PA S -S for 3 Bedrooms _After test If yes, give date ^� Property line i To building foundation 7 To existing or abandoned system on lot Al A On adjacent lots > SL) Cutbank > Water main/service line >/ Surface water IVO Aj1t Driveway, parking/vehicle storage area 2-0 Curtain drain 14 o nl Lf E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on lha date of this inspection. Signature Al Engineer's Name �cco 4t2 Date HAA Fee $ Waiver Fee $ Date of Payment �� - �`� Date of Payment Receipt Number 7T� 3 Receipt Number 72-026 (3/93)' Back " 5 I t () � � 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 A' Application Date/ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name kaC 1 1, OAX Telephone: Home :5'19 - 410 Na_ Business �6 3 Applicant Address I ax� (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder V; Buyer ❑ ; Other ❑ (explain); - (d) Lending Institution Address _— (e) Real Estate Company and Agent Address Telephone -- (f) Mail the HAA to the following address: 2. TYPE OF RESIDEN Single -Family Multi -Family ❑ Other Number of Bedrooms 3 Telephone 3. WATER SUPPLY/ Individual Well [3Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11,84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.. i _ I Address '- a IN[ �6S!.:7�i►�����s���1���i� 07 v ° e •Eng ' eer's Seal C) rucylJ. Corwin -c t✓� J�°. fJ0. CE -5:)E3 �:�✓ DHEP APPROVAL Approved for ` ' bedrooms by Approved _— _— Disapproved' Conditional _ Terms of Conditional Approval CAUTION Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11; 64) MUNICIPALITY OF ANCHORAG2 DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) N 0 v 2 A ffi CHECKLIST - FEBRUARY 1984 2644720 ']71L��A ?K F WO ` Legal Description: R'1�`S_ A. WELL DATA Well Classification i(y) It�(_Loi If A, B, C, D.E.C. Approved (Y/N) d L4 "*T Well Log Present (Y/NDate Completed 31 Mau, ' iA(,o Yield D•� pM 0w 1 kir peo -d Total Depth 4 Cased to �y�• 5/ Depth of Grouting IVIA Static Water Level 141(o, ` Pump Set At iyy2, Casing Height Above Ground Sanitary Seal on Casing (Y/N) u�5 Electrical Wiring in Conduit (Y/N) W Depression Around Wellhead (Y/N) ATO Separation Distances from Well: f To Septic/Holding Tank on Lot ; On Adjoining Lots L00 To Nearest Edge of Absorption Field on Lot I0;'r ; On Adjoining Lots 100,4 To Nearest Public Sewer Line 14 A. To Nearest Public Sewer ,� In Cleanout/Manhole X. A- To Nearest Sewer Service Line on Lot t1 'V A Water Sample Collected by b. 14A) 6k ( ; Date 1!7 / 01 1 ', j Q pt n.l n .1! _ Water Sample Test Results Comments *111-IIlea ` -* Mme- � Pry B. SEPTIC/HOLDING TANK DATA Date Installed 1011118qSize No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) 'V a Foundation Cleanout (jY/N)U �-- N� Date Last Pum � Depression over Tank (Y/N) ped ' VLI�J Pumping/Maintenance Contract on File (Y/N) At A. ; for -� Holding Tank High -Water Alarm (Y/N) N. A. Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: $r To Water -Supply Well III, To Building Foundation t To Property Line �J To Disposal Field To Water Main/Service Line I `� �• To Stream, Pond, Lake, or Major Drainage Course N � IN I ©I)t 4— Comments From b RETbi ot-1 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ilmm Type of System 11 Designs m X Date Installed to _ 11' p)1�/ Length of Field Yo VF Width of Field 31 kjws Depth of Field 9 1 Gravel Bed Thickness $ Square Feet of Absorption Area b 59. �'� Standpipes Present (Y/N) �� S Depression over Field (Y/N) _ No Date of Last Adequacy Test -% ?' VOU TT�r� 1R8(0 Results of Last Adequacy Test RCU01-AOX Q(_ `I'If-k bka foorM r Separation Distance from Absorption Field: To Water -Supply Well leaf To Property Line ' To Building Foundation To Existing or Abandoned System on Lot a.Ar ; On Adjoining Lots - •'F /V r 70 To Water Main/Service Line • A• To Cutbank (if present) N.A. resent) To Stream/Pond/Lake/or Major Drainage Course 100'+- /V A To Driveway, Parking Area, or Vehicle Storage Area 012, Comments 4- From _D4EP 9 f Ips D. LIFT STATION Date Inst led Size in Gallo "Pump On" Level High Water Alarm Level at Tested for Electrical Codes (Y -A _ Dimensions Manhole/ ss (Y/N) ump Off- Level at Vent (Y/N) Pumping Cycles during Adeq "' Check PermiJ$ed Bedroom Rating Against HAA Request " I certify that e c Signed Company Receipt No. yboi - ob Date of Payment j I -�1"�0 rob Amount: $ to 45 Page 2 of 2 72-026 (11/84) Meets MOA or c_ onfgcmed to all MOA and HAA guidelines in effect on the date of this inspection. l --Date 16 /UQ V' rml6r, j 9 (� DSO MOA No Engineer's Seal AW ,a . • as.a••••n•W._ U J. Corwin Q :• o. CF. -r"83 = i � `-gad / Ao i Engineer's Seal MUNICIPALITY OF ANCHORAG DIVISION OF ENVIRONMENTAL HEaI TH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Descriptio (include lot, blojek, subdivision, section, township, range) Location (add ess--o; directions) 7 (b) Applicants NameJ�_"_ / - w Telephone Ho�e � � Busineesss 7 �� Applicants Address e— (c) Applicant is (check one) Lending Institution ; Owner/builder• Buyer E::1 ; Other [:::I (explain); (d) Lending Institution ///�� �f,,�� Telephone Adtgs s 71 1 (e) Real Estate Co. & Agent Address 'Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family, Multi -Family Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well 5:1 Community = Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite � Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 W- 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval shows that the on -sits water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm �� S �r'lj � ijf -7 S , i1�� Telephone :731/ 9 Address��- Date -,) A 0ow ;��e eseoc.�o aoe •cmo•awny:emas� (ENGINEER EPLU ),!,� C ;.y••••o�oy soii�Bo •p •nab • p .TH MlaS R. SIA F � r:, e 2248-E •e`''d 6. DHEP Approval 4 -�„ •.• •.• Approved for bedrooms By Date Approved` Disapproved Conti itional^ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (M(*%) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: �C A. WELL DATA �P17WM(«/v �(IE�i) PSTATCS Well Classification )A tnlUi J)(A _ If A, B, cr C, D.E.C. Approved(Y/N) Well Log Present (Y/N) � _ Date Canpleted N},4 31, /1 S4-- Yield_ Total Depth Z�-% Cased to 2-41. S Depth of Grouting Static Water Level 125- / amp Set At 240 " Casing Height Above Ground 2-.5' Sanitary Seal on Casing (142LICZ Electrical Wiring in Conduit (Y/N) yES Depression Around Wellhead (Y ) Separation Distances fran Well: To Septic/Holding Tank on Lot 1 I FT On Adjoining Lots >100 To Nearest Edge of Abscrption Field on Lot IO Z / On Adjoining Lots >(cy l To Nearest Public Sewer Lire 6yIA To Nearest Public Sewer IF Cleancut/Manhole n)/4 To Nearest Sewer Service Line on Lot — ) Water Sample Collected By Date 2 g Water Sample Test Results -Amc Ccmients B. SEPTIC/HOLDING TANK DATA Date Installed (oZ/Size ) 000 Q --A(_ No. of Canpartments Standpipes (Y/N) `E5 Air -tight Caps (Y/N) ye.� Foundation Cleanout (Y/N) y� Depression over Tank (Y/N) r,10 Date Last Pumped AJ/s}- Pumping/Maintenanae Contract on File (Y/N) ^I/A- ; for t JEh1.SYSTEM Holding Tank High -Water Alarm (Y/N) /y /A- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wall 111 Ft To Building Foundation 7 To Property Line "-2-01 To Disposal Field 7/ To Water Main/Service Line To Stream,•Pond, Lake, cr Major Drainage Course n! Comments Receipt # AD80 OC� Date Paid: - - Q,(-4 Amount (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design =:U Date .Installed &A I -aq Length of Field—e4 Q Width of Field Depth of Field 't lo" Gravel Bed Thickness S " Square Feet of Absorption Area 4co Standpipes Present (YIN) yQ Depression over Field (Y/N) A((o Date of Last Adequacy Test /JA Results of Last Adequacy Test /) 1A - Separation Distance from Absorption Field: To meter -Supply Well 102 / To Property Line To Building Foundation 2-01 To Existing or Abandoned System a: Lot_ AJIA- : On Adjoining Lots 'J/'4 To Water Main/Service Line -/= To Cutbank(if present) AjIA To Stream/Pond/Lake/cr Major Drainage Course iU /A To Driveway, Parking Area, or Vehicle Storage Area JZ7 Comments D. LIFT STATION AJ APDL[ Date Installed Dimensions Size in Gallons "Pump On" Leve 1 at Manhole/Access (YM) "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(YM) Cotments ** Check Permitted Bedroon Rating Against HAA Request ** I certify that I have checked, verified, cr conformed to all MOA HAA on the date of this inspection. Signed Date 5,4,bv Sid Cottpany S S ��UG-,rNLS MOA No. STS Dom RBI/d5/s (Page 2 of 21 in effect ®eeee Z� • esPr� . • e• •e.�ep.'rt' � THOMAS R. e 92-48—E 2-15-84